Cardiovascular Risk Factors and Biomarkers in the Prediction of Cognitive Decline in Older Adults—A Narrative Review

Background: Cognitive decline is a major health concern in older adults and results from a complex interaction between neurodegenerative, vascular, metabolic and inflammatory processes. Cardiovascular and metabolic risk factors may contribute to cognitive impairment through mechanisms including endothelial dysfunction, cerebral hypoperfusion, microvascular damage, oxidative stress and chronic low-grade inflammation. Circulating biomarkers reflecting these processes may provide additional information regarding cognitive vulnerability in older adults. In this context, the present narrative review aims to summarize current evidence on cardiovascular and metabolic risk factors and peripheral biomarkers associated with cognitive decline in older adults, with particular emphasis on their potential role in risk stratification and preventive strategies. Methods: We conducted a literature search in PubMed, Scopus and Google Scholar, focusing primarily on studies published in English between January 2020 and August 2026. The search strategy included combinations of terms related to cognitive decline, older adults, cardiovascular and cardiometabolic risk factors and circulating biomarkers. Peer-reviewed observational and interventional studies, systematic reviews and meta-analyses addressing cognitive outcomes in adults aged 60 years or older were considered. Results and Conclusions: Alterations in lipid profiles and apolipoproteins, glucose metabolism, adipokines, inflammatory markers, homocysteine, cardiac and thrombotic biomarkers, growth differentiation factor-15 (GDF-15) and markers of endothelial activation such as soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) have been associated with cognitive decline in older adults. However, the strength and direction of these associations vary according to age, comorbidities, frailty and the biomarker investigated. Current evidence suggests that cardiovascular and metabolic risk factors and related biomarkers are associated with cognitive outcomes in older adults through interconnected vascular, metabolic and inflammatory pathways. Integrating cardiovascular and metabolic biomarkers with multidimensional geriatric and cognitive assessment may complement risk assessment and help identify older adults who are potentially vulnerable to cognitive decline. However, further prospective studies are required to establish clinically useful thresholds and validate multimarker predictive models.